ISQUA17-2824QUALITATIVE EVALUATION OF LOW-DOSE HIGH-FREQUENCY LEARNING EXPERIENCES TO IMPROVE NEWBORN OUTCOMES AND QUALITY OF CARE, GHANA

Abstract

Objectives: Intrapartum stillbirth and newborn mortality in the first 24 hours of life remain high in Ghana. A low-dose/high frequency (LDHF) training package on care during labor and the postnatal period was designed to give health workers in maternity wards the knowledge and skills needed to address these problems. The intervention included two 4-day on-site (low-dose) trainings followed by weekly (high-frequency) midwife-led practice sessions, and one year of mMentoring, or use of SMS messages about content covered during the low-dose sessions and in-person and telephone supervision by regional mentors Parallel to a cluster-randomized evaluation conducted between March 2014 and March 2017, a qualitative study was conducted to understand the experiences of health workers and stakeholders involved in implementation of the LDHF training approach. The main aim of this study was to investigate acceptability and sustainability of the LDHF training approach. Methods: A combination of semi-structured in-depth interviews and focus group discussions was used to investigate experiences and opinions about the LDHF training approach in providing quality maternal and newborn care services. In total, 20 in-depth interviews and nine focus group discussions were conducted with individuals who participated in and benefitted from the implementation of the LDHF training package at 40 facilities in three regions of Ghana. Findings were analysed using thematic content analysis methods. Coding and analysis of themes from the codebook was done using the Atlas.ti version 7.0 qualitative analysis software. Ethical approval and oversight was provided by Johns Hopkins Bloomberg School of Public Health Institutional Review Board and the Ghana Health Service Ethics Review Committee. Results: The study revealed that providers made tremendous improvements in quality of care at the time of labor, birth and the immediate postnatal period (in all areas taught during the knowledge and skills-focused training). Comments from informants indicated that they were likely to use the newly learned interventions since they felt "empowered to work effectively and with boldness". In addition, this training approach is more practice than theoryoriented and all health workers from the maternity were invited to the on-site trainings. The mMentoring package employed subsequent to the low-dose trainings provided clinical reminders to health workers via SMS and was exceptional because it provided constant reminders to improve knowledge retention and practice. Regular practice with the MamaNatalie and NeoNatalie simulators (Laerdal) was perceived by health workers as easy comfortable, and gave insight on how to treat the "baby" as a real newborn in terms of practicing for proper resuscitation. Conclusion: The result of this study showed that LDHF training approach equipped and empowered providers to provide quality maternal and newborn care at the time of labor and birth. Also, stakeholders who accepted this approach to training promised to sustain it and advocated for scale-up to other part of the country.